* Health

If you don’t want to be brave

Women, contraception and medical care

Taking the pill is not always as straightforward as your doctor might lead you to believe

When I was seventeen I started dating my first boyfriend. I told my mother about it and after the usual questions (“Who is he?” “When can I meet him?”) she said to me: “well, you need to go on the pill”. I was awkward about this. “Why?”, I said. “So you don’t fall pregnant”, she said, matter-of-factly. My response was perhaps predictable: “Gross, mum, we aren’t even having sex yet”. She said, “you want to be prepared in advance”. I told her I didn’t want to go on the pill yet, and she told me that was fine, but that I should tell her when I did, so we could go to the doctor together.

Sometime later I went to the GP, on my own. I didn’t particularly want to update my mother on the matter, so I didn’t tell her. I went in to see my usual GP: a nice, kind, older man. I don’t remember many details about the appointment, but I remember that getting the pill was quick and easy. I said something like, “I want to go on the pill” and he said “OK” and wrote the script. I filled it, and took the first one as directed. Soon, I had stomach cramps and told my mother that I’d started the pill. She was annoyed I hadn’t told her in advance. I said the stomach cramps were so bad that maybe I should stop taking it. She told me to wait, that it would pass. It did pass.

Taking the pill then became a part of my life. I had an alarm set on my phone, every day for 8.30am, with the label “Pill!!”. I took the little pill, and then went about my day. That was it. It was so easy. Apart from those initial cramps, I had no side effects.

Seven years passed like this. Boyfriends came and went, but I kept taking that little pill. Every day at 8.30am.

When I was 24, I experienced the worst migraine of my life. I had been getting migraines, accompanied by what is called “aura”, a few times a year since I was about thirteen (in fact, I still get them). Migraine with aura is a really bad headache, together with visual disturbance (that’s the aura). In my case, I lose my peripheral vision and see spots and white lights. Usually it doesn’t last very long. But this migraine was worse. First, I temporarily lost sensation in one hand. Then, the aura came. And then I experienced severe pain and pressure in my head and on my eyes for almost two weeks. I thought it would never end. I went to the doctor, at the same clinic where I got the pill when I was seventeen (it’s where I always went). They did some tests, I got an MRI. It was all clear, just an atypical migraine.

A close friend had recently qualified as a doctor. I told her about my migraine. She said, “wait, aren’t you on the pill?” I said I was. She told me that I shouldn’t be on the combination pill if I have migraines with aura and that I should speak to my GP. I followed her advice and went to the GP. He wasn’t the same one who had initially prescribed the pill, but he was at the same clinic, and had been renewing the prescription for me for years. He agreed I should stop taking the pill. He told me that taking the combination pill when you have migraine with aura can increase the risk of stroke. I thought: was he serious? The risk of stroke? I have been taking a pill every day for seven years that – because of my migraines with aura – increases the risk of stroke? The risk of stroke?!

I stopped the pill. I never took it again.

I was recently recounting this story to two friends, Annie and Erin (not their real names). They weren’t shocked. They were not at all surprised that a 17 year old girl was given an oral contraceptive pill without any questions or explanations of side effects or investigation into her medical history. Nor were they surprised that the prescription was renewed again and again, every few months, by doctors over the next seven years without any question or discussion.

In fact, they had stories of their own.

When Annie was about twenty-two, she had been on the pill for a long time too. But something changed. She started experiencing difficulty having sex with her boyfriend. She found it uncomfortable, and had no sex drive. She went to her GP. He told her she was fine, that there were no issues.

Annie wasn’t happy with this answer. She knew something must be wrong. She could feel it. Annie booked an appointment with a gynaecologist. He examined her and said “you’re fine to have sex, there is nothing wrong”.

Annie still wasn’t happy. She was worried. She knew something must be wrong. So she went to another gynaecologist. The doctor identified that the problem was with the pill Annie was on. She suggested a number of other contraceptive options for Annie. Annie found one that worked for her, and stopped the pill. It resolved her issues entirely.

Erin started taking the pill in her mid-twenties. It had been prescribed by a GP she trusted. But after Erin started taking the pill she experienced severe mood swings, depression, and felt unstable. She went to see her GP. She explained her symptoms, said she believed they had been caused by the pill, and asked for the alternatives. The doctor said there was no evidence to suggest the pill would have the effects Erin was describing. She told Erin the pill wasn’t the problem; she should keep taking it. Erin pushed back. “I want to go off the pill and I want an alternative”, she said, firmly. The doctor said she ought to use condoms. Erin wasn’t happy with that answer. She told the doctor that she was in a relationship and condoms were not a good option for her and her partner. “What about the IUD or implanon?”, Erin asked. She told the doctor she’d heard good things about them. “No”, said the doctor. “Use condoms”.

Erin wasn’t satisfied. She found a new GP. She explained the symptoms and her belief that the pill was affecting her mental health. “Oh yes”, the doctor said. “There is plenty of anecdotal evidence that suggests the pill can have this effect.” (Also, it turns out the evidence is not just anecdotal. For instance, this study.) The doctor explained the alternatives and they decided on the IUD.

Erin went to a specialist to get the IUD inserted. She had heard from friends that the procedure can be painful. She had also read articles like this one. So, at the initial consultation, Erin asked that the specialist put her under general anaesthetic for the procedure. “Oh, sure”, he said, “if you don’t want to be brave, I’ll book that in”.

If you don’t want to be brave.

Just about every woman I know has a story like this one. They are extraordinarily common. Many (although, of course, not all) doctors are nonchalant and insensitive when it comes to women’s health. Some seem to bring a certain carelessness to contraception in particular. Why is that? It is that it’s all a bit awkward? Is it that they don’t receive adequate training? Is it that they think taking a pill to alter your hormones literally every day is as normal as breathing? And that, it being so ordinary, it shouldn’t come with considered and careful consultation?

There are, as always, additional dimensions and complexities. I’m white. So are Annie and Erin. We are learning more and more that racism plays a significant role in healthcare. These stories may well have been far worse if we were women of colour.

We are also privileged. What if I didn’t have a friend who was a doctor, to tell me what questions to ask? And what if Erin and Annie hadn’t pushed back on their doctors. What if they hadn’t found better doctors? What if they didn’t have the time, money or knowledge to pursue better options? Would they have persevered with contraception that was negatively impacting their lives?

Of course, the issue isn’t the pill, necessarily. The pill has in many ways been a wonderful advancement for women. It gave women control over their fertility, and offered them independence and the ability to take control of their education and careers. It liberated sex from procreation.

And plainly, the pill works for some women. It doesn’t work for others. That’s because our bodies are different. Some of us have migraine with aura! So the problem isn’t the pill. The problem is that the medical support and consultation we receive for our health (in particular, when it comes to contraception) is often second rate.

In my view, the medical profession needs to begin taking stories like mine, and Erin’s and Annie’s seriously.

They are part of a broader picture, of bias and sexism in medicine. That sexism is manifest in myriad ways. From the way women’s pain is ignored, to the way medical research ignores women’s experiences.

Perhaps if stories like these are taken a little more seriously, they might become less common. Maybe, then, a woman’s request for an anaesthetic for a painful procedure won’t be met with the words: “if you don’t want to be brave”.